ThriveOn Contact Form for 2025 Deductible Plan

The deadline to complete the Reduced Deductible incentive (Online Health Assessment & Annual Physical) was August 31, 2024. You can see if you have been placed in the standard or incented deductible plan for 2025 by logging into fccBenefits.com, selecting My Plans, and clicking “As of 01/01/2025” from the dropdown menu. The first box will indicate which plan (standard or incented) you are in.
 
If you feel that you have been placed in the wrong deductible plan for 2025 you must fill out the contact form below no later than December 22, 2024. A ThriveOn staff member will follow-up within 3 business days.

Employee First Name:
Employee Last Name:
Employee Date of Birth:	CalendarToday
Employee Phone Number:
Employee Email:
Spouse/Domestic Partner First Name:
Spouse/Domestic Partner Last Name:
Spouse/Domestic Partner Date of Birth:	CalendarToday
Online Health Assessment:	Yes No Unsure I confirm that both myself and my spouse/domestic partner (if applicable) completed the Online Health Assessment by 8/31/24.
Annual Physical:	Yes No Unsure I confirm that both myself and my spouse/domestic partner (if applicable) completed an Annual Physical with a Primary Care Provider by 8/31/24.
Month of Employee Physical:	Select a Month January February March April May June July August September October November December
Month of Spouse/Domestic Partner Physical:	Select a Month January February March April May June July August September October November December